Bledsoe v1 ch11_lecture

Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Paramedic Care: Principles & Practice
Volume 1, 5e
Chapter 11
Human Life Span
Development

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Multimedia Directory
Slide 6 Treatment Across the Life Span Video
Slide 72 Pharmacology and the Older Adult
Video
Slide 74 Nutrition and Aging Video

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Standard
• Life Span Development

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Competency
• Integrates comprehensive knowledge of life span
development.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Introduction
• People change over span of lifetime.
• Changes in size, appearance, vital signs, body
systems, psychosocial development.
• Some changes make it necessary to adjust
treatment of patients.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Treatment Across the Life Span Video
Back to Directory
Click here to view a video on the topic of treating patients of different ages.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Introduction
• Developmental Stages
– Infancy: birth to 12 months
– Toddler: 12 to 36 months
– Preschool age: 3 to 5 years
– School age: 6 to 12 years
– Adolescence: 13 to 18 years
– Early adulthood: 19 to 40 years
– Middle adulthood: 41 to 60 years
– Late adulthood: 61 years and older

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 11-1 People change over the span of a lifetime.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
• Physiologic Development
– Greatest changes in range of vital signs are in pediatric
patients.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Table 11-1 Normal Vital Signs
Pulse
(Beats
per
Minute)
Respiration
(Breaths
per Minute)
Blood
Pressure
(Average
mmHg)
Temperature
Infancy:
At birth:
At 1 year:
100–180
100–160
30–60
30–60
60–90
systolic
87–105
systolic
98–100°F
98–100°F
36.7–37.8°C
36.7–37.8°C
Toddler (12 to 36 months) 80–110 24–40 95–105
systolic
96.8–99.6°F 36.0–37.5°C
Preschool age (3 to 5 years) 70–110 22–34 95–110
systolic
96.8–99.6°F 36.0–37.5°C
School-age (6 to 12 years) 65–110 18–30 97–112
systolic
98.6°F 37°C
Adolescence (13 to 18 years) 60–90 12–26 112–128
systolic
98.6°F 37°C
Early adulthood
(19 to 40 years)
60–100 12–20 120/80 98.6°F 37°C
Middle adulthood
(41 to 60 years)
60–100 12–20 120/80 98.6°F 37°C
Late adulthood
(61 years and older)
* * * 98.6°F 37°C
*Depends on the individual's physical health status.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Younger the child, more rapid pulse and respiratory
rates.
– At birth, heart rate 100 to 180 beats per minute; settles
at 120 beats per minute.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Initial respiratory 30 to 60 breaths per minute; drops to
30 to 40 breaths per minute.
– Tidal volume initially 6 to 8 mL/kg; increases to 10 to 15
mL/kg by 12 months of age.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Normal range for blood pressure related to age and
weight of infant; tends to increase with age.
– Systolic blood pressure increases from 60 to 90 at
birth; 87 to 105 at 12 months.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Normal birth weight: 3.0 to 3.5 kg.
– First week of life, drops by 5 to 10 percent.
– During first month, infants grow at 30 grams per day.
– Double birth weight by 4 to 6 months and triple it at 9 to
12 months.
– Infant's head equal to 25 percent of total body weight.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 11-2 Infants double their weight by 4 to 6 months old and triple it by 9 to 12 months.
(© Michal Heron)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Shortly after birth, ductus venosus constricts.
– Blood pressure changes; foramen ovale closes.
– Ductus arteriosus constricts after birth.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Once closed, blood can no longer bypass lungs by
moving from pulmonary trunk directly into aorta.
– Leads to increase in systemic vascular resistance;
decrease in pulmonary vascular resistance.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– First breath infant takes is forceful.
– Lungs of fetus secrete surfactant.
– Surfactant: chemical that reduces surface tension;
holds moist membranes of lungs together.
– After first breath, lungs expand; breathing becomes
easier.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Airway shorter, narrower, less stable, more easily
obstructed.
– "Nose breather" until 4 weeks of age.
– Important nasal passages stay clear.
– Lung tissue fragile; prone to barotrauma.
– Rapid respiratory rates lead to rapid heat and fluid loss.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Chest wall less rigid than adult's.
– Ribs positioned horizontally, causing diaphragmatic
breathing.
– Kidneys not able to produce concentrated urine.
– Easily become dehydrated; develop water and
electrolyte imbalance.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Fetus acquires some of mother's active immunities
against pathogens.
– Breast-fed baby receives antibodies through breast
milk.
– Sensation present in all portions of body at birth.
– Lacks ability to localize pain and isolate response to it.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Moro reflex (startle reflex): when baby is startled, he
throws his arms wide, spreading his fingers and then
grabbing instinctively with arms and fingers.
 Should be brisk and symmetrical.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Palmar grasp: strong reflex in full-term newborn.
 Elicited by placing a finger firmly in infant's palm
 Grasp weakens as hand becomes less continuously fisted

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Rooting reflex: causes hungry infant to turn his head to
the right or left when hand or cloth touches his cheek.
– Sucking reflex: stroking infant's lips causes sucking
movement.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Fontanelles
 Allow for compression of head during childbirth.
 Rapid growth of brain during early life.
 Diamond-shaped soft spots of fibrous tissue at top skull; bones
eventually fuse together.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Newborn sleeps 16 to 18 hours daily.
– Periods of sleep and wakefulness evenly over 24-hour
period.
– Infants sleep through night within 2 to 4 months.
– Normal infant easily aroused.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Extremities grow in length from growth plates located
on ends of long bones.
– Factors affecting bone development and growth:
nutrition, exposure to sunlight, growth and thyroid
hormones, genetic factors, general health.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Rapid changes during first year of life.
– 2 months: tracks objects with eyes; recognizes familiar
faces.
– 3 months: moves objects to mouth with hands; displays
primary emotions.
– 4 months: drools without swallowing; reaches out to
people.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– 5 months: sleeps through night without waking for
feeding; discriminates between family and strangers.
– 5 to 7 months: teeth appear.
– 6 months: sits upright; makes one-syllable sounds.
– 7 months: fear of strangers; moods shift from crying to
laughing.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– 8 months: responds to word "no"; can sit alone; plays
"peek-a-boo."
– 9 months: responds to adult anger; pulls to standing
position; explores objects by mouthing, sucking,
chewing, biting.
– 10 months: attention to name; crawls.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– 11 months: attempts to walk without assistance; shows
frustration about restrictions.
– 12 months: walks with help; knows name.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
• Psychosocial Development
– Begins at birth; develops as result of instincts, drives,
capacities, interactions with environment.
– Key component is family.
– Reciprocal socialization: child's active role in own
development.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Crying: newborn's only means of communication.
– Bonding based on secure attachment; infant's sense
that needs will be met by caregivers.
– Anxious resistant attachment: uncertain whether or not
caregivers will be responsive or helpful when needed.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Anxious avoidant attachment: infant has no confidence
he will be responded to helpfully when he seeks care.
– Trust vs. mistrust: develops trust based on consistent
parental care; if irregular and inadequate care,
develops anxiety, insecurity, mistrust, hostility.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Scaffolding: building on what they already know.
– Easy child: regular body functions; low or moderate
intensity of reactions; acceptance of new situations.
– Difficult child: irregular body functions; intense
reactions; withdrawal from new situations.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Infancy
– Slow-to-warm-up child: low intensity of reactions;
somewhat negative mood.
– First stage of parental-separation reaction is protest.
– Second stage is despair.
– Last stage is detachment or withdrawal.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Toddler and Preschool Age
– Toddlers (12 to 36 months)
 Heart rate: 80 to 110 beats per minute.
 Respiratory rate: 24 to 40 breaths per minute.
 Systolic blood pressure 95 to 105 mmHg.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 11-3 A toddler beginning to stand and walk on his own.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Preschoolers (3 to 5 years old)
 Systolic blood pressure: 75 to 110 mmHg.
 Rate of weight gain slowing dramatically; gains 2.0 kg per year.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 11-4 In the preschool-age child, exploratory behavior accelerates.
(© Dr. Bryan E. Bledsoe)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Capillary beds better developed.
– Hemoglobin levels approach normal adult levels.
– More surfaces for gas exchange to take place in lungs.
– Immature chest muscles; cannot sustain excessively
rapid respiratory rate for long.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Kidneys well developed.
– Passive immunity lost; susceptible to
respiratory/gastrointestinal infections.
– Brain 90 percent of adult weight.
– Muscle mass/bone density increased.
– All primary teeth by age 36 months.
– Visual acuity 20/30; hearing reaches maturity at 3 to 4
years.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– 1 year: grasps that words mean something.
– 3 to 4 years: has mastered basics of language.
– 18 to 24 months: understands cause and effect;
develops separation anxiety.
– 24 to 36 months: "magical thinking"; engages in play-
acting.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Exploratory behavior accelerates.
– Plays simple games; follows basic rules.
– Play provides emotional release.
– First-born child often finds it difficult to share attention
of parents with younger sibling.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Younger children often see apparent privileges
extended to older children.
– Peers provide information about other families and
outside world.
– Interaction with peers are opportunities for learning
skills, comparing oneself to others, feeling part of
group.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Authoritarian parents: demanding and desire instant
obedience from child.
 Leads to children with low self-esteem and low competence.
 Boys often hostile; girls often shy.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Authoritative parents: respond to the needs and wishes
of their children.
 Leads to children who are self-assertive, independent, friendly,
cooperative.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Permissive parents: tolerant, accepting view of
children's behavior (aggressive and sexual behavior).
 Leads to impulsive, aggressive children who have low self-
reliance, low self-control, low maturity, lack responsible
behavior.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Nearly half of today's marriages end in divorce.
– Child's physical and psychological way of life often
changes.
– Toddlers and preschoolers express feelings of shock,
depression, fear parents no longer love them.
– Parent's ability to respond to child's needs greatly
influences effects.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Television violence increases levels of aggression;
increases acceptance of use of aggression by others.
– Parental screening helps to avoid these outcomes in
toddlers and preschoolers.
– Modeling: recognize sexual differences; incorporate
gender-specific behaviors observed in parents,
siblings, peers.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
School Age
– 6 and 12 years of age
 Gains 3 kg per year; grows 6 cm per year.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
School Age
– Has developed decision-making skills.
– Is allowed more self-regulation.
– Development of self-concept.
– Develops self-esteem; negative self-esteem damaging
to further development.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
School Age
– Moral development begins.
– Preconventional reasoning:
 Stage one: punishment and obedience.
 Stage two: individualism and purpose.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
School Age
– Conventional reasoning:
 Stage three: interpersonal norms; seeking approval of others.
 Stage four: develop social system's morality.
– Postconventional reasoning:
 Stage five: community rights as opposed to individual rights.
 Stage six: universal ethical principles.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 11-5 School-age children are allowed more self-regulation and independence as they
grow older.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Adolescence
– Adolescents (13 to 18 years)
 Rapid 2- to 3-year growth spurt.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Adolescence
– Girls finished growing by 16; boys 18.
– Both males and females reach reproductive maturity.
– Secondary sexual development occurs.
– Development of external sexual organs.
– Females: menstruation begins.
– Muscle mass/bone growth nearly complete.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 11-6 Children reach reproductive maturity during adolescence.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Adolescence
– Adolescent strives for autonomy; parents strive for
continued control.
– Biological changes cause inner conflict.
– Privacy becomes extremely important.
– Increase in idealism.
– Try to achieve more independence.
– Self-consciousness and peer pressure increase.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Adolescence
– Become interested in others in a sexual way.
– Identity development depends on how well they are
able to handle crises.
– Antisocial behavior peaks around eighth or ninth grade.
– Body image is great concern.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Adolescence
– Eating disorders common.
– Self-destructive behaviors begin.
– Depression and suicide more common.
– Develop personal code of ethics.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Early Adulthood
• 19 to 40 years
– Heart rate: 70 beats per minute.
– Respiratory rate: 12 to 20 breaths per minute.
– Blood pressure: 120/80 mmHg.
– Develop lifelong habits and routines.
– Peak physical condition: 19 to 26.
– End of this period, body begins slowing process.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 11-7 Peak physical conditions occur in early adulthood.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Early Adulthood
• 19 to 40 years
– Accidents leading cause of death.
– Highest levels of job stress.
– Love develops (romantic/affectionate).
– Childbirth common.
– Not associated with psychological problems related to
well-being.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Middle Adulthood
• 41 to 60 years
– Heart rate: 70 beats per minute.
– Respiratory rate: 12 to 20 breaths per minute.
– Blood pressure: 120/80 mmHg.
– Body still functions at high level.
– Vision and hearing changes.
– Cardiovascular health becomes concern.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 11-8 People in middle adulthood still function at a high level.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Middle Adulthood
• 41 to 60 years
– Cancer concerns.
– Weight control difficult.
– Women late 40s to early 50s, menopause commences.
– More concerned with "social clock."
– "Empty-nest syndrome."
– Financial commitments for elderly parents and young
adult children.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Late Adulthood
• Human beings: maximum life span approximately
120 years.
• Life expectancy: average number of additional
years of life expected for member of a population.
• Human beings almost always die of disease or
accident before they reach their biological limit.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Late Adulthood
– 61 years of age and older
 Heart and respiratory rate, blood pressure: depends on
physical health status.
 Cardiovascular system changes: affect its overall function.
 80 years of age: 50% decrease in vessel elasticity.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Late Adulthood
– Heart shows disease in heart muscle, heart valves,
coronary arteries.
– Functional blood volume decreases.
– Increased likelihood for older adults to develop lung
disease and progressive declines in lung function.
– Smoking produces greatest amount of disability.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Late Adulthood
– Decrease in glucose metabolism and insulin
production.
– Age-related dental changes; false teeth.
– Swallowing takes 50 to 100 percent longer.
– 1 of 3 people over 60 has diverticula.
– Constipation when narcotics ingested.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Pharmacology and the
Older Adult Video
Click here to view a video on the topic of pharmacology and the older adult
patient.
Back to Directory

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Late Adulthood
– Changes occur in metabolism and absorption.
– 25 to 30 percent decrease in kidney mass.
– Kidney's hormonal response to dehydration reduced.
– Taste buds diminish.
– Smell declines rapidly after age 50.
– Appetite often declines.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Nutrition and Aging Video
Back to Directory
Click here to view a video on the topic of nutrition and aging.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Late Adulthood
– Response to painful stimuli, visual acuity, reaction time
diminished.
– Changes in organs of hearing; affect hearing.
– Changes in memory function.
– Sleep-wake cycle disrupted.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Late Adulthood
– Ability to learn and adjust continues throughout life.
– Influenced by interests, activity, motivation, health,
income.
– Terminal-drop hypothesis: decrease in cognitive
functioning over 5-year period prior to death.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 11-9 The ability to learn and adjust continues throughout life.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Late Adulthood
– Home-care services: assistance with household
chores; perform personal care tasks.
– Health care services: in home by nurses and physical
or speech therapists.
– Eligible for these services under Medicare.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Late Adulthood
– Assisted living: facility that offers combination of home
care and nursing home facilities.
– 95 percent of older adults live in communities.
– Challenges: maintaining sense of self-worth; feeling of
declining well-being.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Late Adulthood
– Retirement usually means decrease in income and in
standard of living.
– Decreasing level of interest in work is natural.
– 22 percent of older people live in households below
poverty level.
– 50 percent of all single women above age of 60 live at
or below poverty level.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Late Adulthood
– Grief follows death; when advance warning, grief may
precede death.
– Death or impending death of companion leads to fear
for our own lives.
– Everyone must deal with each of the stages of grieving
before process ends.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Summary
• Some stages (birth through preschool) changes
seem to occur daily.
• Infant through adolescent constitutes pediatric
population.
• Know typical developmental characteristics of
each age.
• You will be better prepared to evaluate a sick or
injured pediatric patient.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Summary
• Compare child's current state to established norm;
determine if there is significant difference.
• Not every person develops at same rate and in
same way.
• Established norms are only guidelines.
• They should never take the place of thorough
assessment and history.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Summary
• Only through experience will you feel comfortable
dealing with patients at each of stage of life.
• No matter what stage of development, a thorough
assessment, patience, and sincere desire to help
will guide you to make right emergency care
decisions for each patient.

Bledsoe v1 ch11_lecture

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